Decisions, Decisions

Hello! Welcome back!

Imagine for a moment you happen to walk by the room where I am practicing music therapy with a patient or client. You observe me offering a client with dementia song choices, singing the song they choose, and prompting and encouraging them to also sing or play an instrument.

It looks very basic on the surface, right?

But there is so much going on inside the mind of a music therapist in those moments related to the musical decisions we make and how we make them.

In the context of using music for therapy, as opposed to music education, or entertainment, musical decisions are clinical decisions, too.

So before we even get to that basic musical interaction between therapist and client, a music therapist is considering:

• What periods of this person's life does he or she tend to be most responsive to and nostalgic over? What decade in time is most likely to spark a strong emotional response or elicit meaningful engagement with memories?
• What do we know about the limitations imposed by their disease process? Do they need a slower tempo in order to catch their breath to sing?
• What about this particular client's vocal range? Does this song need to be pitched in a key that's not super comfortable for me, but better for the client's voice?
• What portions of the song should I be singing? Should I do the whole thing, or only the chorus several times because they don't remember the verses and I will loose their engagement if we try to sing them?
• How loudly does this person need me to sing in order to hear me, but not get overstimulated?
• Will cuing them with body language, chord structure, and rhythm changes be enough to help them sing along, or does this person need verbal cues, as well?

And prior to those questions, I'll be asking myself about this person's affect, energy level, pain needs, and so many other factors to decide if it's even the right time and place for this person to have a musical interaction.

Contrast that sort of decision-making process with how a performer or entertainer might plan their set list. The motivators are primarily going to be what that performer wants to do, balanced with some consideration about what the audience will enjoy.

But in therapy, every musical choice I make is guided by my clients and their treatment plan. So I may sing something I am 100% burnt-out on, not because I particularly want to, but because I know it will be most likely to help my clients achieve their treatment goals.

These kinds of considerations are critical because music therapists do not throw music at problems and see what sticks. We provide musical therapeutic intervention for the treatment of our clients and patients. We must know we are providing safe and effective treatments. The training and expertise an MT-BC brings to patient care makes us well worth the cost and effort to bring music therapy to every clinical setting.

I hope I live to see the day where every person who could benefit from MT has the chance to receive services. In the meantime, you'll see me out there, singing "You are My Sunshine," for the 12th time this week and loving it.